Provider Demographics
NPI:1992018691
Name:FAIRFIELD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:FAIRFIELD MEMORIAL HOSPITAL
Other - Org Name:BLUE GRANITE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:803-635-0233
Mailing Address - Street 1:P.O. BOX 620
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0620
Mailing Address - Country:US
Mailing Address - Phone:803-635-0288
Mailing Address - Fax:803-635-0262
Practice Address - Street 1:880 WEST MOULTRIE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-2411
Practice Address - Country:US
Practice Address - Phone:803-635-0288
Practice Address - Fax:803-635-0262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFIELD MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-154261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health